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Don’t go breaking your heart

World Heart Day, 29 September 2017

On World Heart Day Professor Konstantinos Makrilakis speaks about the relationship between diabetes and cardiovascular disease.

Powered by blood, our heart is the engine of our life and our health. Being heart healthy allows us to love, laugh and live to the full. Keeping care of our blood and our heart is therefore crucial for our health especially for someone with diabetes. In fact, diabetes and cardiovascular diseases (CVD) have a deadly relationship since high blood pressure, high cholesterol, high blood glucose and other risk factors contribute to increasing the risk of cardiovascular complications in people living with diabetes. Not surprisingly, CVD is the most common cause of death and disability in people with diabetes: adults with diabetes are two to four times more likely to have heart disease or a stroke than adults without diabetes. It is estimated that at least 68% of people with diabetes aged 65 or older die from some form of heart disease, and 16% die of stroke.

On World Heart Day, we spoke to Professor Konstantinos Makrilakis, about engine, lifestyle and unbroken heart. Prof Makrilakis is Associate Professor in Internal Medicine at the first Department of Propaedeutic Medicine and the Diabetes Center, National and Kapodistrian University of Athens Medical School, Laiko General Hospital, Athens, Greece, and member of the Board of the International Diabetes Federation, European Region.

Can you explain to us, in simple terms, the relation between diabetes and cardiovascular diseases (CVD)?

Your heart works as a pump in the body, in other words like an engine that propels blood. So if you consider that your heart is an engine, then your blood is its fuel. If your fuel is damaged, it slowly deteriorates your engine, leading to major engine troubles. High levels of blood glucose can make the blood coagulation system more active (increasing the risk of blood clots) and also causes damage to your blood vessels all over the body, among which your heart vessels. Diabetes is associated with high blood pressure and cholesterol levels as well, which also lead to increased risk of cardiovascular complications such as angina, coronary artery disease (CAD), myocardial infarction, stroke, peripheral artery disease (PAD), and congestive heart failure.

Today, diabetes is considered the strongest risk factor for heart disease: an adult with diabetes is two to four times more likely to die from heart disease than one without this condition. According to the IDF Diabetes Atlas, 7th edition, 5 million people died of diabetes in 2015 around the world, 627.000 in Europe alone. Most of these deaths were a result of cardiovascular complications.

As you can see, there is, unfortunately, a strong relation between diabetes and CVD. And with over 60 million adults with diabetes in the continent, the condition is, unfortunately, a leading heartbreaker.

The positive news is that this deadly relation can be broken or at least delayed. What are the measures which a person with diabetes can take?

We all know that lifestyle measures including a healthy diet, no smoking and a good level of physical activity are crucial to prevent most of the complications linked to diabetes. This is also the case for cardiovascular diseases. Therefore, people with diabetes must adopt measures to control their glycaemia, avoid or control hypertension and abnormal cholesterol, quit - or better never start – smoking and try to lead an active (non-sedentary) lifestyle, avoiding obesity or overweight. You do not need to run a marathon or climb the Eiffel tower to be active and protect your heart: the universally accepted World Health Organisation recommendations state that adults aged 18–64 should perform at least 150 min/week of moderate activity including walking, gardening, household chores…. or 75 min/week of vigorous physical activity. This target can easily be reached by practically everyone.

What has been done in your country to prevent diabetes and CVD? What should be done at the national, European and international level?

In Greece the Hellenic Diabetes Association (HDA) has been struggling for years to educate health care providers and the lay public about the merits of controlling glycaemia and living a healthy lifestyle for managing and preventing the disease and its complications. In addition to seminars and congresses organized in various parts of the country every year, a guide containing “Guidelines for the management of the person with diabetes” as well as a “Nutritional Guide for controlling diabetes” have been produced a few years ago and are regularly updated (they are both freely available on its website: www.ede.gr). Furthermore, the role of the community is also extremely important to help prevent CVD in people with diabetes and a lot of effort is being made to involve the municipalities and local communities in spreading the “healthy lifestyle concept” to their citizens.

By community I also mean Europe. Great efforts have also been made at the continental level, and as a Board Member, I am really proud to mention it, through the activities of IDF Europe. For example, as a member of the European Chronic Disease Alliance, (www.alliancechronicdiseases.org) IDF Europe is involved in the development of position papers and policy statements impacting the prevention of diabetes and CVD. Similarly, we have collaborated with the European Society of Cardiology to the development, of the last two editions of the European Guidelines on cardiovascular disease prevention (2012 and 2016).

As a Greek I must quote Aristotle: “The whole is truly greater than the sum of its parts”. We are all part of a greater community, the global community, and tremendous efforts have been made lately by the International Diabetes Federation. In 2016, we launched a very interesting publication on “diabetes and cardiovascular disease” which contains recommendations targeted at the national government including:- Implementation of public health policies and lifestyle interventions to increase healthy eating and physical activity- Prioritisation of the control of blood pressure and access to essential medicines- Implementation of non-communicable disease monitoring systems- Legislation and implementation of policies that eliminate the use of tobacco

IDF Europe is the European chapter of the International Diabetes Federation (IDF). We are an umbrella organization representing 70 national diabetes organisations in 47 countries across Europe. We are a diverse and inclusive multicultural network of national diabetes associations, representing both people living with diabetes and healthcare professionals.